Women's life satisfaction following the delivery in the context of their mood, relationships and resiliency

Jednym z głównych tematów eksplorowanych w kontekście psychologicznych uwarunkowań okresu poporodowego pozostaje depresja poporodowa. Bez cienia wątpliwości jest to bardzo poważne zaburzenie, które niesie za sobą wiele negatywnych konsekwencji nie tylko dla samej kobiety, ale również dla całego jej systemu rodzinnego. O ile, poszukiwania uwarunkowań wszelakiego rodzaju psychopatologii są nieodzownym elementem badań naukowych, nadal stawia to człowieka w kategoriach braku lub deficytu. Zgodnie jednak z perspektywą psychologii humanistycznej, czy pozytywnej, każda jednostka posiada również motywację wzrostu, która kieruje ją w stronę optymizmu, szczęścia i zadowolenia z życia. Dlatego też obszar badawczy niniejszej pracy skoncentrowany jest na poszukiwaniu korelatów szczęścia i dobrostanu w tak szczególnym momencie, jakim jest okres okołoporodowy oraz rok po porodzie. W niniejszej pracy skupiono się na zbadaniu poziomu satysfakcji z życia kobiet w okresie od 4 tygodnia do 12 miesięcy po porodzie oraz zadano pytania, jakie czynniki mogą ewentualnie działać w służbie dobrostanu kobiety, która właśnie została mamą. Postawiono hipotezy, iż satysfakcja ze związku partnerskiego oraz prężność psychiczna mogą w znaczący sposób przyczyniać się do poprawy satysfakcji z życia, a obniżony nastrój działać na jej niekorzyść. Sprawdzano również, czy zmienne demograficzne oraz zmienne położnicze korespondują z wyżej wymienionymi zmiennymi psychologicznymi. 107 kobiet wypełniło ankietę, a finalnie wyniki 99 z nich zostały poddane weryfikacji. Osobami badanymi były głównie mężatki z wyższym wykształceniem, mieszkające na terenach wiejskich oraz w miastach powyżej 500 tysięcy mieszkańców. Średnia wieku w badanej grupie wyniosła 30,33 lata, przy odchyleniu standardowym: SD = 4,91. Wyniki przeprowadzonych badań potwierdziły, iż zarówno satysfakcja ze związku partnerskiego, jak i prężność psychiczna, współwystępują z satysfakcją z życia, przy czym odporność psychiczna pełni istotniejszą rolę jako predyktor dobrostanu, niż satysfakcja ze związku. Ponadto wykazano zależności dobrostanu z miejscem zamieszkania oraz statusem ekonomicznym. Z przeprowadzonych analiz wynika także, iż mężatki odznaczały się wyższym zadowoleniem ze swojego związku w porównaniu do kobiet niezamężnych. Badanie potwierdziło również korelację dobrostanu z niektórymi zmiennymi położniczymi (opieka ginekologiczno-położnicza, stan zdrowia matki), jednak siły efektu tych związków pozostawały na niskim poziomie. Zaobserwowano również, że grupa przebadanych kobiet (n=99) odznaczała się wysokimi wynikami na skali Edynburskiej skali depresji poporodowej, a jak wykazano również w tym badaniu, obniżony nastrój współwystępował z obniżoną satysfakcją z życia, satysfakcją ze związku oraz obniżoną prężnością. Badania te po raz kolejny potwierdziły istotność głębokiej relacji z partnerem romantycznym, która ma podwójne znacznie: nie tylko chroni przed depresją poporodową, ale także działa w służbie dobrostanu kobiet. Kolejnym wnioskiem jest również fakt, że jednak w kontekście dobrostanu, większe znaczenie miała prężność psychiczna. Ważnym wnioskiem, związanym z występowaniem w badanej grupie nasilonych symptomów depresji poporodowej, jest również zwiększenie czujności w kontekście zmian nastoju kobiet w kolejnych tygodniach i miesiącach po porodzie.One of the main topics explored in the context of psychological conditions during the postpartum period is postpartum depression. Without a shadow of a doubt, this is a very serious disorder that carries many negative consequences not only for the woman herself but also for her entire family system. While investigating the determinants of various types of psychopathology is an essential element of scientific research, it still categorizes individuals in terms of lack or deficit. However, according to the perspective of humanistic or positive psychology, each individual also possesses a motivation for growth that directs them towards optimism, happiness, and life satisfaction. Therefore, the research area of this study is focused on seeking correlates of happiness and well-being in the unique moment of the perinatal period and the year after childbirth.In this study, the focus was on examining the level of life satisfaction of women from the 4th week to 12 months after childbirth, and questions were posed regarding the factors that may potentially contribute to the well-being of a woman who has just become a mother. Hypotheses were formulated that satisfaction with the partner relationship and psychological resilience can significantly contribute to an improvement in life satisfaction, while a lowered mood can have adverse effects. The study also explored whether demographic and obstetric variables correspond to the aforementioned psychological variables. 107 women completed the survey, and ultimately the results of 99 of them were verified. The participants were mainly married women with higher education, living in rural areas and cities with populations exceeding 500,000 residents. The average age in the study group was 30.33 years, with a standard deviation of 4.91.The results of the conducted research confirmed that both satisfaction with the partner relationship and psychological resilience coexist with life satisfaction, with psychological resilience playing a more significant role as a predictor of well-being than partner satisfaction. Additionally, associations between well-being, place of residence, and economic status were demonstrated. The analyses also indicated that married women exhibited higher relationship satisfaction compared to unmarried women. The study also confirmed correlations between well-being and certain obstetric variables (obstetric-gynaecological care, maternal health status), but the strength of these relationships remained low. It was also observed that the group of surveyed women (n=99) displayed high scores on the Edinburgh Postnatal Depression Scale, and as demonstrated in this study, a lowered mood was associated with decreased life satisfaction, decreased partner satisfaction, and decreased psychological resilience as well.Once again, these studies underscore the significance of a deep romantic partner relationship, which holds dual importance: it not only protects against postpartum depression but also serves the well-being of women. Another conclusion is that psychological resilience had greater significance in the context of well-being. An important takeaway, related to the intensified symptoms of postpartum depression in the studied group, is the increased vigilance regarding changes in women's mood in the following weeks and months after childbirth

TIAR and FMRP shape pro-survival nascent proteome of leukemia cells in the bone marrow microenvironment

Summary: Chronic myeloid leukemia (CML) cells circulate between blood and bone marrow niche, representing different microenvironments. We studied the role of the two RNA-binding proteins, T-cell-restricted intracellular antigen (TIAR), and the fragile X mental retardation protein (FMRP) in the regulation of protein translation in CML cells residing in settings mimicking peripheral blood microenvironment (PBM) and bone marrow microenvironment (BMM). The outcomes showed how conditions shaped the translation process through TIAR and FMRP activity, considering its relevance in therapy resistance. The QuaNCAT mass-spectrometric approach revealed that TIAR and FMRP have a discrete modulatory effect on protein synthesis and thus affect distinct aspects of leukemic cells functioning in the hypoxic niche. In the BMM setup, FMRP impacted metabolic adaptation of cells and TIAR substantially supported the resistance of CML cells to translation inhibition by homoharringtonine. Overall, our results demonstrated that targeting post-transcriptional control should be considered when designing anti-leukemia therapeutic solutions

Frailty increases mortality among patients ≥ 80 years old treated in Polish ICUs

Background: The increasing population of very old intensive care patients (VIPs) is a major challenge currently faced by clinicians and policymakers. Reliable indicators of VIPs’ prognosis and purposefulness of their admission to the intensive care unit (ICU) are urgently needed. Methods: This is a report from the Polish sample of the VIP1 multicentre cohort study (NCT03134807). Patients ≥ 80 years of age admitted to the ICU were included in the study. Information on the type and reason for admission, demographics, utilisation of ICU procedures, ICU length of stay, organ dysfunction and the decision to apply end-of-life care was collected. The primary objective was to investigate the impact of frailty syndrome on ICU and 30-day survival of VIPs. Frailty was assessed with the Clinical Frailty Scale (≥ 5 points on a scale of 1–9). Results: We enrolled 272 participants with a median age of 84 (81–87) years. Frailty was diagnosed in 170 (62.5%) patients. The ICU and 30-day survival rates were equal to 54.6% and 47.3% respectively. Three variables were found to significantly increase the odds of death in the ICU in a multiple logistic regression model: SOFA score (OR = 1.16; 95%CI 1.16–1.24), acute mode of admission (OR = 5.1; 95%CI 1.67–15.57) and frailty (OR = 2.25; 95%CI 1.26–4.01). Conclusion: Measuring frailty in critically ill older adults can facilitate making more informed clinical decisions and help avoid futile interventions.Background: The increasing population of very old intensive care patients (VIPs) is a major challenge currently facedby clinicians and policymakers. Reliable indicators of VIPs’ prognosis and appropriateness of their admission to theintensive care unit (ICU) are urgently needed. Methods: This is a report from the Polish sample of the VIP1 multicentre cohort study (NCT03134807). Patients≥ 80 years of age admitted to the ICU were included in the study. Information on the type and reason for admission,demographics, utilisation of ICU procedures, ICU length of stay, organ dysfunction and the decision to apply end-of--life care was collected. The primary objective was to investigate the impact of frailty syndrome on ICU and 30-daysurvival of VIPs. Frailty was assessed with the Clinical Frailty Scale (≥ 5 points on a scale of 1–9). Results: We enrolled 272 participants with a median age of 84 (81–87) years. Frailty was diagnosed in 170 (62.5%)patients. The ICU and 30-day survival rates were equal to 54.6% and 47.3% respectively. Three variables were found tosignificantly increase the odds of death in the ICU in a multiple logistic regression model, namely: SOFA score (OR = 1.16;95% CI: 1.16–1.24); acute mode of admission (OR = 5.1; 95% CI: 1.67–15.57); and frailty (OR = 2.25; 95% CI: 1.26–4.01). Conclusion: Measuring frailty in critically ill older adults can facilitate making more informed clinical decisions andhelp avoid futile interventions

The impact of frailty on ICU and 30-day mortality and the level of care in very elderly patients (≥ 80 years)

Purpose: Very old critical ill patients are a rapid expanding group in the ICU. Indications for admission, triage criteria and level of care are frequently discussed for such patients. However, most relevant outcome studies in this group frequently find an increased mortality and a reduced quality of life in survivors. The main objective was to study the impact of frailty compared with other variables with regards to short-term outcome in the very old ICU population. Methods: A transnational prospective cohort study from October 2016 to May 2017 with 30 days follow-up was set up by the European Society of Intensive Care Medicine. In total 311 ICUs from 21 European countries participated. The ICUs included the first consecutive 20 very old (≥ 80 years) patients admitted to the ICU within a 3-month inclusion period. Frailty, SOFA score and therapeutic procedures were registered, in addition to limitations of care. For measurement of frailty the Clinical Frailty Scale was used at ICU admission. The main outcomes were ICU and 30-day mortality and survival at 30 days. Results: A total of 5021 patients with a median age of 84 years (IQR 81–86 years) were included in the final analysis, 2404 (47.9%) were women. Admission was classified as acute in 4215 (83.9%) of the patients. Overall ICU and 30-day mortality rates were 22.1% and 32.6%. During ICU stay 23.8% of the patients did not receive specific ICU procedures: ventilation, vasoactive drugs or renal replacement therapy. Frailty (values ≥ 5) was found in 43.1% and was independently related to 30-day survival (HR 1.54; 95% CI 1.38–1.73) for frail versus non-frail. Conclusions: Among very old patients (≥ 80 years) admitted to the ICU, the consecutive classes in Clinical Frailty Scale were inversely associated with short-term survival. The scale had a very low number of missing data. These findings provide support to add frailty to the clinical assessment in this patient group. Trial registration: ClinicalTrials.gov (ID: NCT03134807)

Sepsis at ICU admission does not decrease 30-day survival in very old patients: a post-hoc analysis of the VIP1 multinational cohort study

Background: The number of intensive care patients aged ≥ 80 years (Very old Intensive Care Patients; VIPs) is growing. VIPs have high mortality and morbidity and the benefits of ICU admission are frequently questioned. Sepsis incidence has risen in recent years and identification of outcomes is of considerable public importance. We aimed to determine whether VIPs admitted for sepsis had different outcomes than those admitted for other acute reasons and identify potential prognostic factors for 30-day survival. Results: This prospective study included VIPs with Sequential Organ Failure Assessment (SOFA) scores ≥ 2 acutely admitted to 307 ICUs in 21 European countries. Of 3869 acutely admitted VIPs, 493 (12.7%) [53.8% male, median age 83 (81-86) years] were admitted for sepsis. Sepsis was defined according to clinical criteria; suspected or demonstrated focus of infection and SOFA score ≥ 2 points. Compared to VIPs admitted for other acute reasons, VIPs admitted for sepsis were younger, had a higher SOFA score (9 vs. 7, p < 0.0001), required more vasoactive drugs [82.2% vs. 55.1%, p < 0.0001] and renal replacement therapies [17.4% vs. 9.9%; p < 0.0001], and had more life-sustaining treatment limitations [37.3% vs. 32.1%; p = 0.02]. Frailty was similar in both groups. Unadjusted 30-day survival was not significantly different between the two groups. After adjustment for age, gender, frailty, and SOFA score, sepsis had no impact on 30-day survival [HR 0.99 (95% CI 0.86-1.15), p = 0.917]. Inverse-probability weight (IPW)-adjusted survival curves for the first 30 days after ICU admission were similar for acute septic and non-septic patients [HR: 1.00 (95% CI 0.87-1.17), p = 0.95]. A matched-pair analysis in which patients with sepsis were matched with two control patients of the same gender with the same age, SOFA score, and level of frailty was also performed. A Cox proportional hazard regression model stratified on the matched pairs showed that 30-day survival was similar in both groups [57.2% (95% CI 52.7-60.7) vs. 57.1% (95% CI 53.7-60.1), p = 0.85]. Conclusions: After adjusting for organ dysfunction, sepsis at admission was not independently associated with decreased 30-day survival in this multinational study of 3869 VIPs. Age, frailty, and SOFA score were independently associated with survival

Withholding or withdrawing of life-sustaining therapy in older adults (≥ 80 years) admitted to the intensive care unit

PURPOSE: To document and analyse the decision to withhold or withdraw life-sustaining treatment (LST) in a population of very old patients admitted to the ICU. METHODS: This prospective study included intensive care patients aged ≥ 80 years in 309 ICUs from 21 European countries with 30-day mortality follow-up. RESULTS: LST limitation was identified in 1356/5021 (27.2%) of patients: 15% had a withholding decision and 12.2% a withdrawal decision (including those with a previous withholding decision). Patients with LST limitation were older, more frail, more severely ill and less frequently electively admitted. Patients with withdrawal of LST were more frequently male and had a longer ICU length of stay. The ICU and 30-day mortality were, respectively, 29.1 and 53.1% in the withholding group and 82.2% and 93.1% in the withdrawal group. LST was less frequently limited in eastern and southern European countries than in northern Europe. The patient-independent factors associated with LST limitation were: acute ICU admission (OR 5.77, 95% CI 4.32-7.7), Clinical Frailty Scale (CFS) score (OR 2.08, 95% CI 1.78-2.42), increased age (each 5 years of increase in age had a OR of 1.22 (95% CI 1.12-1.34) and SOFA score [OR of 1.07 (95% CI 1.05-1.09 per point)]. The frequency of LST limitation was higher in countries with high GDP and was lower in religious countries. CONCLUSIONS: The most important patient variables associated with the instigation of LST limitation were acute admission, frailty, age, admission SOFA score and country. TRIAL REGISTRATION: ClinicalTrials.gov (ID: NTC03134807)

Management and outcomes in critically ill nonagenarian versus octogenarian patients

Background: Intensive care unit (ICU) patients age 90 years or older represent a growing subgroup and place a huge financial burden on health care resources despite the benefit being unclear. This leads to ethical problems. The present investigation assessed the differences in outcome between nonagenarian and octogenarian ICU patients. Methods: We included 7900 acutely admitted older critically ill patients from two large, multinational studies. The primary outcome was 30-day-mortality, and the secondary outcome was ICU-mortality. Baseline characteristics consisted of frailty assessed by the Clinical Frailty Scale (CFS), ICU-management, and outcomes were compared between octogenarian (80-89.9 years) and nonagenarian (>= 90 years) patients. We used multilevel logistic regression to evaluate differences between octogenarians and nonagenarians. Results: The nonagenarians were 10% of the entire cohort. They experienced a higher percentage of frailty (58% vs 42%; p < 0.001), but lower SOFA scores at admission (6 +/- 5 vs. 7 +/- 6; p < 0.001). ICU-management strategies were different. Octogenarians required higher rates of organ support and nonagenarians received higher rates of life-sustaining treatment limitations (40% vs. 33%; p < 0.001). ICU mortality was comparable (27% vs. 27%; p = 0.973) but a higher 30-day-mortality (45% vs. 40%; p = 0.029) was seen in the nonagenarians. After multivariable adjustment nonagenarians had no significantly increased risk for 30-day-mortality (aOR 1.25 (95% CI 0.90-1.74; p = 0.19)). Conclusion: After adjustment for confounders, nonagenarians demonstrated no higher 30-day mortality than octogenarian patients. In this study, being age 90 years or more is no particular risk factor for an adverse outcome. This should be considered- together with illness severity and pre-existing functional capacity - to effectively guide triage decisions